Individual
ROBERT DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 W BURNSIDE AVE, POCATELLO, ID 83202-4916
(208) 238-9000
Mailing address
210 W BURNSIDE AVE, POCATELLO, ID 83202-4916
(208) 590-8259
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC10498
ID
101YM0800X
Mental Health Counselor
Primary
LPC-10498
ID
Other
Enumeration date
05/23/2024
Last updated
03/26/2026
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